Senior Leader, Clinical Regulatory Operations — Hybrid

Cambia Health

Fargo (ND)

Hybrid

USD 114,000 - 188,000

Full time

9 days ago

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Benefits offered by this job

Hybrid work model

Comprehensive benefits

Job summary

Cambia Health is seeking an Assistant Director of Clinical Regulatory Operations to lead a regulatory operations team across multiple health plan programs. The role focuses on ensuring CMS, state and NCQA compliance while promoting operational excellence and value for members.

The ideal candidate will drive improvement through data analytics, automation and structured improvement methods, while partnering with Legal, Compliance and clinical leaders to align processes across locations and lines

Qualifications

Bachelor's degree in Healthcare Administration, Nursing, Public Health, or related field (Master's preferred)
5+ years of leadership experience
7+ years in health insurance/managed care with regulatory compliance or clinical operations

Responsibilities

Partner with Regulatory Affairs, Quality, Legal, Compliance and clinical leaders to interpret and operationalize new regulatory requirements across HSO programs.
Serve as strategic partner to clinical leadership to improve affordability, efficiency, quality and member experience within regulatory guardrails.
Design and implement regulatory compliance programs using structured improvement models (PDSA, Lean, Six Sigma).
Establish audit and monitoring processes with automation, dashboards, and real‑time reporting.
Lead NCQA accreditation readiness activities including gap assessments and mock audits.
Manage department budget, staffing, and succession planning.